| NPI | 1063632602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305S00000X Point of Service (Licence: KS 17-00935) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: KS 17-00935) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |